Chronic Obstructive Pulmonary Disease (COPD) Care Pathway

Blue Circles
Green Circles
Happy elderly lady on tablet chatting with family members who live on the other side of the country

Dr. Bourbeau and Living Well with COPD by RESPIPLUS have partnered with Aetonix to create a COPD Care Pathway that facilitates better health outcomes, globally with the aTouchAway platform.

Dr. Jean Bourbeau has pioneered COPD research at the Research Institute of the McGill University Health Centre (RI-MUHC). His expertise in the self-management of COPD combined with Aetonix’s powerful virtual care technology, means many COPD patients will benefit from superior care leading to successful self-management of their disease, no matter where they live.

Improve Patient Outcomes Do not enter used to image reduced readmissions

The aTouchAway™ platform dramatically improves patient outcomes through virtual communication, remote patient monitoring, care plan management, and clinical workflows. Its strength is being able to connect patients and clinicians through remote monitoring — crucial as the world struggles with COVID-19.

RESPIPLUS™ will harness the power of Aetonix’s mobile care platform, aTouchAway™, to enhance the delivery of its Living Well with COPD program. This program, supported by more than 40 scientific publications, provides COPD patients with educational resources for self-management while aiding physicians and healthcare professionals.

Aetonix Enters into Dynamic Partnership with RESPIPLUS™ to Enhance Delivery of World-Renowned COPD Self-Management ProgramIcon of bar chart with arrow going up from left to right demonstrating the aging population in North America

How it worksIcon of bar chart with arrow going up from left to right demonstrating the aging population in North America

The COPD Care Pathway runs a daily patient assessment and guides the patient on actions to take to avoid hospital readmission. The patient status will be color-coded and notifications delivered to the care team on the criticalness of the intervention required. The patient will be presented with educational material, based on symptoms identified, to help address issues and avoid unnecessary visits to the clinic. Educational resources include information on inhalers, breathing positions, and other topics.

Frequently Asked Questions Do not enter used to image reduced readmissions

What is a Care Pathway?

A Care Pathway is a methodology that better enables patients to be connected to their care providers. It can include clinical protocols and workflows, virtual communications (voice and message), educational and coaching material for both the caregiver and the patient, assessment forms, surveys and questionnaires, and vital stats collection via remote patient monitoring.

What’s included in the Living Well with COPD Care Pathway?

With the COPD Care Pathway, patients can expect:

  • Guided education sessions covering COPD topics such as, managing symptoms and medication, being active and having a healthy lifestyle, breathing and airway clearance techniques, using and action plan and much more.
  • Additional ‘preparation’ and ‘post session’ educational resources to enhance patient integration and self-management
  • Daily monitoring of COPD symptoms to help identify exacerbations

Healthcare professionals can expect:

  • Simplified follow-up of people with COPD, adapted to their needs and level of severity
  • Automated assessment and evaluation forms for easy entry and reference
  • Agile process for patients, including notifications and reminders (eg. prompting to complete homework prior to the next education sessions)

Has the care pathway been patient validated?

The COPD Pathways integrated into the aTouchAway platform, are based on the successful results of the Living Well with COPD program (LWWCOPD). This self-management program was originally developed in 1998 and since then it has been tested in multiple clinical studies across the world, and it is supported by over 40 scientific publications. The LWWCOPD program has been adapted to 14 languages and it is used in a variety of clinical settings, attesting the program’s positive effects in improving patients lives while making a more effective use of healthcare resources. The LWWCOPD program is currently run by a non-profit society, RESPIPLUS™.

Can we make modifications to the care pathway for our specific hospital/care organization?

Select changes are available for patient onboarding and consent, as well as the identification of any other relevant and local resources that are useful for patients. For more information on how the COPD Care Pathway can be tailored to your organization’s needs, please contact us.

How would we go about deploying it to our patients?

Our teams at Aetonix and RESPIPLUS™ will make sure to provide your personnel the highest level of training to make sure that they develop the skills to support long-lasting behaviour change in the clientele affected by this chronic disease. Our trainers have extensive expertise in deployment with a focus on quality control and intervention fidelity (using the COPD Pathways as they are intended to).

Is this care pathway suitable for all patient types, such as seniors with zero technical skills?

Yes, zero technical skill is required and the patient interface can be modified and locked remotely to meet the technical ability of the user. The patient types include those affected by COPD. Your clinic may have a varied representation of patients, ranging from young (+40 yrs) and tech-savvy to seniors with co-morbid conditions and some cognitive impairment. The aTouchAway platform has been designed to accommodate all these user types.

When is the Care Pathway available for deployment?

Aetonix’s exciting partnership with the Live Life Well Program by RESPIPLUS™ is launching soon! The COPD Care Pathway will be available on February 9, 2021. We look forward to working with healthcare organizations around the world to deliver the best health outcomes for COPD patients.

I'd like to schedule a meeting to discuss our requirements

We would be happy to discuss how we can help your organization implement the COPD Care Pathway. To arrange a meeting, please click here.

Team Members Do not enter used to image reduced readmissions

Headshot of Michel Paquet, Founder and CEO at Aetonix Systems

Michel Paquet  LinkedIn Logo Hyperlinked to Michel Paquet's Profile

Founder and CEO at Aetonix

As a veteran innovator in the technology industry, Michel Paquet’s experience ranges from engineering leadership roles at Nortel, IBM Canada, Wind River Systems, and Intel . Michel has dedicated his time, effort and financial resources over the past 4 years to develop a much needed communications and information sharing platform for seniors and patients with complex health care needs. As the CEO of Aetonix Systems he has demonstrated his extraordinary passion for improving the healthcare experience for patients in Ontario and simplifying communication for those who need it most.

Dr. Jean Bourbeau LinkedIn Logo Hyperlinked to Michel Paquet's Profile

MD, MSc, FRCPC (Respirologist)

Jean Bourbeau is the Director of the Research Institute MUHC’s Center for Innovative Medicine, the COPD Clinic and the Pulmonary Rehabilitation Unit at the MUHC Montreal Chest Institute. He has been President of the Canadian Thoracic Society. His work and research on COPD, pulmonary rehabilitation, integrated self-management programs for patients with COPD (‘Living Well with COPD’) have had an impact not only in the field of research, but also in clinical practice at the national and international level.

Maria Fernanda Sedeno LinkedIn Logo Hyperlinked to Michel Paquet's Profile

Executive Director at RESPIPLUS

Maria Sedeno is the Executive Director of RESPIPLUS, a non-profit organization committed to improving healthcare professionals and patients’ education in the respiratory field. She has co-authored and led the national and international developments of the “Living Well with COPD” and the “Living Well with Pulmonary Fibrosis” programs. These comprehensive self-management educational platforms support patients in making the necessary changes in their lifestyle to better manage their chronic disease.

What our customers say about us

Five star rating

Using the aTouchAway COPD Care Pathway, we have been able to support our patients at home with required respiratory and oxygen therapy, managing them safely and avoiding unnecessary hospital or clinic visits. aTouchAway proves to be effective in augmenting patient care while expanding team capacity and saving travel time for our organization.

Miriam Turnbull

VP & GM at ProResp

Case Study Square. Learn how Aetonix has helped other organizations. Click to read a case study.

Schedule a discovery call

Want to schedule a demo for February 2021, or have any particular questions that you want to be answered as soon as possible? Let’s discuss.

Group of health monitoring devices, like a digital scale, watches, blood pressure machine and a tablet and smartphone with the aTouchAway application opened
close-link
COPD Education – Onboarding

Objective

To complete a thorough needs assessment / initial evaluation for a COPD patient of an outpatient clinic

Actors
Patient, Educator (Nurse, RT, the Physician could also be the educator)

Timelines
One 60-90 min session with the Educator

Description
  • This protocol should be established for all COPD patients from a given clinic, independently of whether they are new patients or they are known to the clinic. This protocol is the basis to engage the patient into other protocols such as education, exacerbation follow-up, etc.
  • We need to identify patient goals/concerns to guide the interventions
  • A thorough evaluation is carried on, with the objective of understanding where the patient is on their disease journey and follow-up treatable traits: dyspnea, exacerbation or dyspnea and exacerbation.
  • It includes the use of objective questionnaires such as the mMRC, CAT, HADS, Frailty Scale, etc.
  • Identify if the patient needs to be referred to other resources (e.g. Physiotherapist, social worker, occupational therapist)
  • Once Onboarding is completed, the patient continues to the COPD Education workflow
close-link
COPD Education – Continuous Maintenance

Objective 

To cover in depth all the necessary elements of self-management education as per the LWWCOPD, with priorities based on patient goals and identified treatable traits

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
A number of “Core” educational modules have been identified which cover the basic COPD education from the LWWCOPD program. Additionally, optional modules can be used to respond to patient needs. The timeline (frequency, number of modules to be covered at a given education session) is fully customizable, although we recommend to have education sessions every 2-weeks during the “active” phase of education. Once this is completed, the patient continues to the Maintenance Mode (see below).

Description
  • Launched at the onboarding protocol
  • Provide basic overview of COPD self-management based on LWWCOPD (medication adherence, inhaler techniques, PLB technique & energy conservation) up to the development of an Action plan for early exacerbation recognition and management.
  • Prioritize self-learning by the patient (e.g. watching videos, reading educational materials, completing homework) in addition to live sessions with the Educator. Educational materials are sent to the patient directly via the platform, and become the patient’s own library. The Educator can customize which “homework” the patient receives.
  • Educators have access to “User guides” to standardise their educational intervention. These user guides include: objectives, interventions, suggested questions, evaluation of self-efficacy, and learning contracts for each module.
  • Once the core education is completed, the patient can continue to the Respiratory Status Follow-up Workflow (run in parallel)

The Maintenance Mode
  • As soon as the maintenance mode is engaged, the frequency of visits Educator/Patient is reduced to once every 6 months.
  • During the Maintenance Mode sessions, the educator has access to all the education modules and can choose any piece of content that needs to covered with the patient. 
  • A streamlined evaluation (similar to the initial eval.) is done during each “maintenance” visit to identify any substantial changes on the patient’s needs that will require some adjustment. The patient could come back to an “active” education mode (more frequent education sessions, e.g. every 2 weeks).
close-link
COPD Respiratory Status Follow-up

Objective

Monitoring of stable patients from a clinic in order to identify early any aggravation of symptoms (exacerbation) and implement an action plan

Actors
Patient, Educator (Nurse, RT or Physician)

Timelines
Scheduled regular automated follow-up to the patient symptoms. Intensity/Frequency can be adjusted by the Educator depending on patient needs (e.g. daily, every week, etc.). Ongoing through the year.

Description
  • Launch: Patients who have completed the Core Educational including setting-up an action plan.
  • Regular automated questions allow to identify any change in patient’s symptoms and severity.
  • If an exacerbation is detected the patient gets a reminder to engage their self-management strategies while waiting for the Educator to call back.
  • An alarm is generated for the Educator, so they immediately call back the patient. At this call they will evaluate any further intervention required and schedule additional follow-up.
close-link
Schedule a Demo

Learn more about aTouchAway’s features and how they can help improve efficiency in your healthcare organization.

close-link
close-link